COVID-19 pandemic impact on clinical outcomes of patients with obstructive pyelonephritis

Abstract

Purpose Obstructive pyelonephritis is a common urologic emergency that requires prompt decompression of the collecting system. The COVID-19 pandemic has changed patient flow and healthcare strategies at numerous emergency departments across Brazil with still unknown consequences for the population. This study sought to investigate the impact of the COVID-19 outbreak on clinical outcomes in patients with acute obstructive pyelonephritis at a tertiary academic center. Materials and methods After Institutional Review Board approval, a retrospective chart review of patients who required decompression of the collecting system due to acute obstructive pyelonephritis from June 2019 to July 2020 was conducted. Basic demographic information, pre-operative, and peri-operative data were recorded. Patients were assigned in "Pre-Covid" and "Post-Covid" groups based on the admission dates. Results A total of 63 patients were included, with 40 patients in the Pre-Covid group and 23 in the Post-Covid group. Patients from the Post-Covid group presented at the ER later after symptoms onset (7.8 vs. 4.3 days; p = 0.012), had higher rates of SIRS (57% vs. 25%; p = 0.012), perirenal abscesses (13% vs. 0%; p = 0.019), overall complications (p = 0.047) and presented longer hospital length of stay (7.6 vs. 3.8; p = 0.007). Conclusion During the COVID-19 pandemic, patients with acute obstructive pyelonephritis presented later for evaluation at the ER, had higher disease severity and longer hospital length of stay when compared to the pre-COVID group of patients with the same pathology.

Impact of COVID‐19 pandemic on patients with obstructing urinary stones complicated by infection

“…Unlike our experience, however, other groups providing proper therapy timelines reported inferior clinical outcome, again suggesting a negative impact of patient delay in presentation. [12][13][14][15]19 We are aware that our study has some limitations. First, it represents the experience of a single tertiary referral medical centre in a highly developed urban region with sufficient resources to cope with regular emergencies as well as the extra burden caused by COVID-19-infected patients.…”

“…Those with obstructing pyelonephritis may have had higher complications rates and SIRS levels, and such delays were translated into higher rates of morbidity and mortality. 18 , 19 A plausible explanation for the patients' reluctance to seek emergency care appears to be public anxiety about exposure to the virus. This issue was not addressed in depth by medical organisations until late into the pandemic, when instructive medical messages started to emerge through mass media.…”

“…Unlike our experience, however, other groups providing proper therapy timelines reported inferior clinical outcome, again suggesting a negative impact of patient delay in presentation. 12 , 13 , 14 , 15 , 19 …”

“…[8][9][10][11] Previous studies that had evaluated the pandemic's impact on stone disease showed that there were significantly fewer patients seeking medical aid. [16][17][18][19] However, there is a paucity of information on the presentation for medical assistance on the part of patients with emergent stone-related infection. This study aimed to assess the influence of the COVID-19 pandemic on the presentation, evaluation and outcomes of patients with obstructing urinary stones complicated by infection.…”

“…Previous studies that had evaluated the pandemic's impact on stone disease showed that there were significantly fewer patients seeking medical aid 16–19 . However, there is a paucity of information on the presentation for medical assistance on the part of patients with emergent stone‐related infection.…”